Connecting for Better Health logo
Connecting for Better Health

Advancing data sharing to improve the health of all Californians

Eligibility and Benefits Specialist

Human ResourcesHuman ResourcesFull TimeRemoteMid LevelTeam 1-10Since 2021H1B No SponsorCompany SiteLinkedIn

Location

Arizona + 11 moreAll locations: Arizona | Florida | Idaho | Louisiana | New Hampshire | North Carolina | Missouri | South Carolina | Tennessee | Texas | Vermont | Virginia

Posted

23 hours ago

Salary

$47K - $52K / year

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

Eligibility and Benefits Specialist

Connecting for Better Health

• Verify patient insurance eligibility, benefits, authorization requirements, and referral needs prior to services. • Obtain referrals from primary care providers and referring physicians, ensuring all referral requirements are met prior to scheduling or treatment. • Track referral status and proactively follow up with provider offices, payers, and patients to ensure referrals are received and remain valid. • Accurately document insurance coverage, benefit information, referrals, and eligibility details within internal systems. • Communicate insurance coverage, patient financial responsibility, estimated out-of-pocket costs, and Oshi's billing model in a clear, professional, and empathetic manner. • Research and resolve eligibility, coverage, referral, and insurance discrepancies that may impact patient care or reimbursement. • Monitor eligibility verification queues, insurance changes, pending requests, and coverage updates to ensure timely resolution. • Identify and resolve claim rejections related to eligibility, benefits, coverage, or referral issues. • Maintain open communication with patients, providers, payers, and internal stakeholders to resolve eligibility, referral, and insurance-related questions. • Collaborate with Billing, Accounts Receivable, Clinical Operations, and other cross-functional teams to improve patient access, billing accuracy, and reimbursement. • Analyze eligibility, referral, and benefit verification data to identify trends, root causes, and opportunities for process improvement. • Monitor and report on eligibility, referral, and verification metrics to support operational performance and continuous improvement. • Contribute to workflow enhancements that improve operational efficiency, reduce claim denials, and enhance the patient financial experience. • Ensure compliance with organizational policies, payer requirements, HIPAA, and healthcare billing and eligibility regulations.

Job Requirements

  • Bachelor's Degree in Business Administration or relevant course work.
  • 2+ years of healthcare revenue cycle experience with a focus on eligibility, benefits, insurance verification, or patient access.
  • Experience verifying insurance eligibility, benefits, authorizations, and obtaining referrals across multiple commercial and government payers.
  • Hands-on experience using payer portals, Availity, and other insurance verification tools, including phone verification.
  • Experience working successfully in a remote work environment with the ability to manage priorities independently.
  • Proficiency with EMR and insurance verification systems.
  • Strong customer service, communication, and interpersonal skills.
  • Strong organizational, analytical, and problem-solving skills with exceptional attention to detail.
  • Proficiency with Google Workspace (Sheets, Docs, Gmail) and the ability to quickly learn new systems and technology.

Benefits

  • Employer-sponsored medical, dental, and vision coverage
  • Unlimited PTO + 11 paid company holidays
  • Eligibility to contribute to 401(k)
  • Tailored professional development opportunities as we scale
  • Access to Overalls, because we know life happens

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